The Producers
Leadership training provides aspiring nurse leaders
with tools to build a better health care system
By Linda Childers
November 29, 2004
When an 8-year-old girl awoke in her hospital bed complaining of pain from her stitches, her mother didn’t immediately push the call button for the nurse. Her daughter had recently received pain medication, and the mother decided to try a different approach. She asked her daughter to practice the guided imagery techniques she’d learned before her surgery.
The child began to envision a colorful hot air balloon pressing against her stitches causing them to hurt. Then she saw her imaginary friend, a beautiful unicorn, popping the hot air balloon. As the imaginary balloon slowly deflated, the girl’s pain seemed to diminish. A half hour later, she was sound asleep.
A nice distraction
Nurses across the country are discovering the benefits of teaching guided imagery to their youngest patients. A study conducted earlier this year by Myra Huth, RN, PhD, assistant vice president of nursing research at Cincinnati Children’s Hospital Medical Center, reported that guided imagery techniques used in combination with pain medication can significantly reduce postoperative pain and anxiety in children.
Huth and two colleagues studied 73 children aged 7 to 12 who were in the hospital to have their tonsils and/or adenoids removed. About half of Huth’s study group learned guided imagery, a method of distraction in which patients focus their attention away from an undesirable sensation.
Patients in the guided imagery group were given instructional videotapes, audiotapes, and booklets on guided imagery before their surgery and asked to practice with the materials before they were admitted to the hospital. They also listened to the audiotape one to four hours after surgery and at home.
The children who learned guided imagery reported significantly less pain and anxiety while hospitalized after their surgery than those who did not receive the instruction.
Nurses who practice guided imagery techniques on patients say that Huth’s findings give credence to a treatment modality that is becoming more accepted.
Lee Rowan, RN, CIIG, of Berkeley, Calif., left her position as an ICU nurse two years ago to open her own guided imagery practice, Imagery for Health.
“I admit I was very skeptical of guided imagery at first,” Rowan says. “The concept seemed as foreign as practicing voodoo or magic.”
After taking classes and achieving a certificate in integrated imagery through a school called Beyond Ordinary Nursing in Foster City, Calif., Rowan became a convert. In her private practice, she sees both children and adults, and says the majority of her patients come to her frustrated and dissatisfied with Western medicine.
“I’ve seen children with sleep disorders, joint pain, and stomachaches desperately seeking ways to relieve their symptoms,” Rowan says.
Rowan meets with new patients for an initial consultation and helps them customize a guided imagery plan to meet their individual needs.
“Children are so imaginative that guided imagery is usually an easy concept for them to grasp,” Rowan says. “They are less resistant than adults to try something new, and don’t have the preconceived notions about guided imagery that many adults have.”
Her sessions begin with children describing their pain or condition and exploring their pain with all five senses. Then Rowan encourages them to invent an imaginary friend who can help soothe their pain and offer relief.
“Guided imagery gives children confidence that they have some control over what’s going on in their bodies,” Rowan says. “Usually after just a couple sessions they feel comfortable enough practicing the techniques in their own homes.”
Rowan also works with children to record customized tapes that can guide them through the imagery process. She recounts stories of patients who have suffered from various conditions and been able to relax their bodies and lessen their discomfort. “I truly feel that practicing guided imagery is allowing me to use my nursing skills to help patients enjoy life to its fullest,” Rowan says.
Use your imagination
At Phoenix Children’s Hospital, nurses work in conjunction with child life specialists to teach their youngest patients guided imagery techniques.
“When we have children experiencing difficulty with pain control, we call on our child life specialists to teach the children guided imagery,” says Charlene Cowley, RN, CPNP, pain management nurse coordinator at Children’s Hospital. “We’ve found pain medications are much more effective when children use guided imagery and can become more relaxed and not as focused on the pain and stress of being in a hospital.”
Many of the nurses at Children’s also have taken courses in guided imagery and use their skills when their young patients become anxious. “If a child is having chronic pain, we immediately begin working with them on learning guided imagery,” Cowley says. “Often, we also train parents, so that they can continue doing guided imagery with the child after leaving the hospital.”
Cowley and other nursing staff have noted that guided imagery not only helps to relax children and increase the effectiveness of pain medications, but also elevates their immune functioning and lessens any anxiety and depression they may be experiencing.
Some children like to imagine they are visiting a favorite place such as a beach or an amusement park. They are encouraged to use all five senses to explore the place, and to realize they can return to their special place whenever they are in pain or feeling anxious.
Other children find that replacing pain with a familiar activity — such as imagining playing soccer, skating, or skiing — helps relieve discomfort. Another technique often used is to have children create a mental image of what the pain looks like and then to visualize another image of something else ending that pain.
“All of our treatment rooms feature hidden pictures in the wall murals,” Cowley says. “We’ll often use these as a way of helping a child imagine they are in a different place. Even with very young children, we can use pop-up books to help stimulate their imagination.”
In a recent Cincinnati Children’s Hospital news release, Huth notes the need for more nurses to receive training in guided imagery techniques or to work closely with their child life specialists to identify patients who might benefit from the practice.
“We need to get better at adequately dosing pain medications in conjunction with using distraction techniques,” Huth says. “Nurses are beginning to think differently about how they practice and how they can help patients and families with nontraditional methods of pain management.”
For more information
Nurses interested in applying for the next Robert Wood Johnson Executive Nurse Fellows Program can find more information and fill out an application online at www.enfp-info.org. Application deadline is Feb. 1. For more information, contact Nichol Randall, program assistant, at (415) 502-6451..